Denial and Appeals Coordinator Full Time

Job Summary

The Denials & Appeals Coordinator serves as the operational driver for timely and effective denial management, working closely with other members of the team, especially utilization management, to ensure no step is missed in preventing and resolving authorization-related denials.

While not a clinical role, this position is critical in executing the processes that protect revenue and keep patient care moving forward.

Essential Functions

• Serves as key team member of the new Central Access and Authorizations Team (CAAT), serving as a subject matter expert on denial prevention and coordination.
• Works with facility to gather clinical information from medical record. Responsibility may include printing and scanning into required systems.
• Ensures all denial-related documentation is complete, accurate, and submitted within required timeframes.
• Collaborates with other members of the CAAT, Business Development, Case Management, and Clinical Teams in denial management process.
• Coordinates and schedules peer to peer physician consults as needed; may work with case management if attending physician is completing peer to peer, or may work directly with physician advisory group to schedule.
• Maintains working knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Participates in continuing education/ professional development activities.
• Learns and has a full understanding of scheduling and pre-register routines in Meditech and any other referral platform utilized by the CAAT team (i.e., Referral Manager).

Knowledge/Skills/Abilities/Expectations

• Team player, able to communicate and demonstrate a professional image/attitude.
• Excellent oral and written communication and interpersonal skills.
• Strong computer skills with both standard and proprietary applications.
• Data entry with attention to detail.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Qualifications

• Education: High School Diploma or GED required, Associates or Bachelors Degree preferred; preference towards a healthcare related area of concentration or be a licensed health care provider or equivalent experience.
• Licenses/Certifications: None Required.
• Experience: 2+ years of healthcare experience. Experience in case management, medical records, billing, utilization review or admissions a plus. Post-acute care and long-term acute care experience a plus.